CARTHAGE  Carthage Area Hospital is laying off 90 employees and eliminating 20 beds in the second restructuring plan within three months, the hospital announced Thursday.

The layoffs equal 20 percent of the hospitals staff, and follow cutbacks at the end of 2013 that eliminated 29 jobs, 18 of them layoffs.

The plan will reduce the number of critical care, medical/surgical and pediatric unit beds from 30 to 10 and consolidate dietary services with Meadowbrook Terrace, the hospitals 60-bed assisted-living facility that opened last year.

As a result, the hospital cafeteria will be closed, according to an employee who asked not to be named for fear that she would lose her job. Some kitchen workers will be transferred to Meadowbrook Terrace, and others will be laid off, the employee said.

A Subway restaurant will open in the hospital to cater to staff, the employee said.

The hospital did not give a breakdown of where positions were being cut. Some employees were notified Thursday, and others will be told today.

The atmosphere at the hospital was tense Thursday evening after the announcement. Many workers leaving for the day refused to comment, and one said the hospital told employees not to discuss the situation even among themselves.

The restructuring at the hospital, 1001 West St., is a result of a changing health-care environment, according to hospital board member Dale A. Klock.

What were talking about is what everyone else is saying, he said. All hospitals are going through this. Its mind-boggling whats going on in the hospital world. (This) is something we need to do.

Increased state and federal regulations, declining reimbursement rates and the shift from inpatient to outpatient care are some of the reasons the hospital has had to switch gears over the past couple of years, he said. At the same time, the hospital has made significant progress in reducing its debt, which at one point reached $21 million.

Mr. Klock said that the restructuring and service alignment plan is something that has been in the works for while, and that interim Chief Executive Officer Adil Ameer has been working on the plan since he came to the hospital in the fall of 2011, after the resignation of then-Administrator Walter S. Becker.

The biggest thing is ironing out how this will look at the end, Mr. Klock said. Its amazing we still have hospitals. Look whats happening in Brooklyn.

He referred to three hospitals in Brooklyn that are barely hanging on while awaiting federal intervention via a $10 billion Medicaid waiver.

The new layoffs at Carthage Area Hospital will occur throughout the organization, which most recently employed 451 employees at the hospital and Meadowbrook Terrace on Cole Road in the town of Champion.

New York State Nurses Association spokeswoman Eliza Bates said she was unaware how many registered nurses would lose their jobs.

Carthage Area nurses are committed to providing quality care for our community, and we are against any cuts that could harm patient care, she said. At this time, were trying to get more information.

Layoffs come about a week after the hospital issued a news release regarding ongoing contract negotiations with NYSNA representatives, to which officials said that if an agreement could not be reached in the near future, the hospital will begin to evaluate the restructuring of programs and services, which potentially could result in reductions in services and staff.

Hospital spokeswoman Natalie M. Burnham said Thursday that the restructuring and service realignment plan was not a result of failed efforts by both parties to reach an agreement.

Calls seeking comment to representatives of Service Employees International Union Local 1199, which represents licensed practical nurses, nurses aides, technicians and clerical, dietary and maintenance workers, were not immediately returned Thursday.

Assemblyman Kenneth D. Blankenbush, R-Black River, issued the following statement Thursday, shortly after the plan announcement: I am disappointed to hear the news that the Carthage Area Hospital will be cutting jobs. Just as we secured state funding to help the hospital implement cost- and job-saving measures, it was dealt another blow by the reductions in reimbursement rates set by the Affordable Health Care Act. Our rural hospitals have been hit very hard. As we learn more details about the hospitals restructuring plan, I will continue to work with my state legislative colleagues to address the health care needs of rural New Yorkers.

According to a Carthage Area Hospital news release, the hospital also recently renewed its transfer agreements with Samaritan Medical Center, Watertown, and Lewis County General Hospital, Lowville.

Samaritan spokeswoman Krista A. Kittle said such an agreement has been in place to ensure Samaritan could accept Carthage hospital patients if Carthage doesnt have enough beds or doesnt offer a service that Samaritan offers. She said there have been no discussions about a formal affiliation between the two hospitals.

Mrs. Burnham said Carthage hospital administrators will work with Samaritan and others to explore potential collaborations and partnership to create efficiencies in the way health care is delivered in the north country.

That aligns with an effort among Carthage Area Hospital and five other regional hospitals to reduce unnecessary repeat Medicaid admissions. Work being done by the local group is ahead of the newly formed North Country Health Systems Redesign Commission, to which members were appointed by the state Department of Health to assess the scope of care in the north country, assess residents health care needs and the systems ability to meet them, recommend ways to ensure providers survive and identify opportunities for mergers, affiliations or partnerships.

It also will make specific recommendations that providers and communities can implement to improve access and develop recommendations for distribution of reinvestment grants.

The Fort Drum Regional Health Planning Organization is interested in seeing any hospital collaborations, according to Executive Director Denise K. Young, who also is a redesign commission member.

This has been an ongoing, How can our hospitals work together? Mrs. Young said.

Meanwhile, in its news release, Carthage Area Hospital said the restructuring plan doesnt change the commitment and the dedication of Carthage Area Hospital and its staff to continue to provide quality health care to the local community.

The big thing people need to take from this is the hospital isnt changing; were still here, Mr. Klock said. Were better aligning ourselves with other hospitals.

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